Aromatherapy (Inhalation) for Pain Management in Labour · for Pain Management in Labour RNM LAI On...
Transcript of Aromatherapy (Inhalation) for Pain Management in Labour · for Pain Management in Labour RNM LAI On...
Aromatherapy (Inhalation)
for Pain Management in Labour RNM LAI On Ki
Delivery Suite Department of Obstetrics & Gynecology
Princess Margaret Hospital Hospital Authority Convention 2017 (F8.5)
Objectives
Provide guidance for practicing Aromatherapy safely & effectively Provide informed choice for labouring women to cope with pain Promote positive experience in labour
Introduction
Aromatherapy Use of Essential oils, derived from aromatic plants,
from therapeutic properties First introduced to Maternity care in early 1990s May shorten duration of labour, reduce anxiety,
fear and pain May reduce the needs for additional pain relief
methods
(Buckle et al 2014, Burns et al 2007, Pollard 2008, Vakilian & Keramat 2013)
Department Recommended Essential Oils
Neroli 橙花 (Citrus auranthium var.
amara)
Sweet Orange 甜橙
(Citrus sinensis)
Bergamot 彿手柑
(Citrus bergamia)
Linalool <38% Limonene <17% β-pinene <12%
Limonene <39% Linalool <8% Linalyl acetate <28%
Limonene <89% Linalool <0.1% Myrcene <2% β-bisabolene <2% Methyl N-Methyl anthranilate <1%
Linadool & Linalyl acetate improved mood states increased parasympathetic nerve activity
Effects: Stimulating & uplifting Calming and balancing Spasmolytic Analgesic Antiseptic, bactericidal & antiviral
(Igarashi 2013 & Rashidi-Fakari et al 2015)
Citrus group essential oils
Selection Criteria
Started from July 2015
Term Pregnancy (≥37 weeks) with no complications
Opt to use Aromatherapy (Inhalation) as pain relief method during labour
Contraindications Allergy or sensitive to the essential oils or citrus
fruits Skin disorders Asthma Epilepsy Renal or Hepatic disease Hypertension or Hypotension Bleeding or bleeding tendency Presence of Uterine Scar
Monitoring & Evaluation Information Sheet • Effects of essential oil • Methods of application
Pre-printed CMS • Verbal consent obtained • Checking eligibility of women
Evaluation Form • Background • Pain Score (0, 30 & 120 mins) • Maternal & neonatal Outcomes
Woman’s Satisfaction Survey • Feedback from women post
delivery
Results (Jul 2015 – Dec 2016)
Background & Labour Outcomes
Neroli (N=34)
Sweet Orange (N=364)
Bergamot (N=247)
Total (N=645)
Parity Nulliparae 21 (61.8%) 275 (75.5%) 196 (79.4%) 492 (76.3%) Multiparae 13 (38.2%) 89 (24.5%) 54 (20.6%) 153 (23.7%)
Onset of labour Spontaneous 15 (44.1%) 145 (39.8%) 102 (41.3%) 262 (40.6%) Induction 19 (55.9%) 219 (60.2%) 145 (58.7%) 383 (59.4%)
Previous experience on Aromatherapy, Yes 2 (5.9%) 36 (9.9%) 21 (8.5%) 59 (9.1%) Mode of Delivery Normal Delivery 24 (70.6%) 259 (71.2%) 155 (62.8%) 438 (67.9%)
Instrumental Delivery 3 (8.8%) 55 (15.1%) 51 (20.6%) 109 (16.9%) Cesarean Section 7 (20.6%) 50 (13.7%) 41 (16.6%) 98 (15.2%)
Duration of using Aromatherapy (Mean, hrs) 4.73 5.16 5.76 5.4 Duration of Labour 1st stage (Mean, hrs) 5.72 7.63 6.05 6.92
2nd stage (Mean, mins) 23 39 44 39.8 3rd stage (Mean, mins) 7 9 9 8.82
Complications Primary PPH 1 (2.9%) 13 (3.6%) 13 (5.3%) 27 (4.2%) Maternal Fever 0 2 (0.5%) 2 (0.8%) 4 (0.6%) Retained Placenta 0 1 (0.3%) 2 (0.8%) 3 (0.5%)
Essential Oil Used
Table 1 Background and Labour Outcomes
Results (Jul 2015 – Dec 2016) (con’t)
Baby Outcomes
Neroli (N=34)
Sweet Orange (N=364)
Bergamot (N=247)
Total (N=645)
Apgar Score at Birth AS<7 (1st min) 0 4 (1.1%) 3 (1.2%) 7 (1.1%) AS<7 (5th min) 0 1 (0.27%) 0 1 (0.2%)
Baby transfer out to Postnatal 29 (85.3%) 273 (75%) 182 (73.7%) 484 (75%) SCBU 5 (14.7%) 89 (24.5%) 61 (24.7%) 155 (24%) NICU 0 2 (0.5%) 4 (1.6%) 6 (0.9%)
Reason to SCBU/NICU Neonatal fever 4 (11.8%) 69 (19%) 47 (19%) 120 (18.6%)
RDS 0 9 (2.5%) 9 (3.6%) 18 (2.8%) Maternal GBS with limited evaluation 1 (2.9%) 5 (1.4%) 1 (0.4%) 7 (1.1%)
Maternal fever 0 0 1 (0.4%) 1 (0.2%) Others* 0 6 (1.7%) 7 (2..8%) 13 (2%)
Skin to Skin Contact, Yes 22 (64.7%) 217 (59.6%) 149 (60.3%) 388 (60.2%) Mode of Feeding Breastfeeding 18 (52.9%) 183 (50.3%) 113 (45.7%) 314 (48.7%)
Artificial Feeding 4 (11.8%) 63 (17.3%) 32 (13%) 99 (15.3%) Mixed Feeding 12 (35.3%) 118 (32.4%) 102 (41.3%) 232 (36%)
*Others (maternal medical conditions, fetal structural & medical problems)
Essential Oil Used
Table 2 Neonatal Outcomes
Results (Jul 2015 – Dec 2016) (con’t)
2015 2016
Essential Oil Used Aroma Group Neroli Sweet
Orange Bergamot
Breastfeeding 1467 (30%)
1206 (24.4%)
18 (52.9%)
183 (50.3%)
113 (45.7%)
314 (48.7%)
Artificial Feeding
976 (15.9%)
1059 (21.4%)
4 (11.8%)
63 (17.3%)
32 (13%)
99 (15.3%)
Mixed Feeding 2455 (50.1%)
2681 (54.1%)
12 (35.3%)
118 (32.4%)
102 (41.3%)
232 (36%)
Table 3 Mode of Feeding on Discharge Home in 2015, 2016 and Aromatherapy Group
Women’s Satisfactory Survey Table 4 Pain Score difference at 30 mins & 120 mins post-Aromatherapy
30 min Post-Aroma PSdiff 120 min Post-Aroma
115 (16.9%)
1
Less
er P
ain
-7
Less
er P
ain
0
38 (7.4%)
0 -6 0
1 -5 0
1 -4 1
5 -3 4
30 -2 12
68 -1 21
41.5% 260 No Change 0 No
Change 90 17.6%
261 (41.6%)
114
Mor
e P
ain
1
Mor
e P
ain
99
384 (75%)
107 2 112
23 3 75
13 4 55
3 5 31
0 6 9
0 7 2
1 8 1
0
50
100
150
200
250
300
-10 -5 0 5 10
Pain Score Difference 30 min Post-Aroma120 min Post-Aroma
More Pain
Lesser Pain
Women’s Satisfactory Survey (con’t) Table 5 Pain Score Difference after Aromatherapy by women self-rated after delivery
Pain Score Difference After Aromatherapy
Lesser Pain
-9 1
171 (26.5%)
-8 0
-7 1
-6 0
-5 0
-4 5
-3 10
-2 57
-1 97
No Change 0 204 31.6%
More Pain
1 87
245 (38%)
2 90
3 28
4 26
5 7
6 5
7 0
8 2
0
50
100
150
200
250
-10 -5 0 5 10
Pain Score Difference after Aromatherapy by women self-rated after delivery
Lesser Pain
More Pain
Women’s Satisfactory Survey (con’t)
Women’s Satisfaction Neroli Sweet
Orange Bergamot Total
Relieving Labour Pain (N=593) Very Much 很多 1 (3.1%) 20 (5.9%) 7 (3.2%) 28 (4.7%) Moderate 一般 10 (31.2%) 79 (23.3%) 50 (22.5%) 139 (23.4%) Some 少許 11 (34.5%) 128 (37.8%) 85 (38.3%) 224 (37.8%) Not at all 沒有 10 (31.2%) 112 (33%) 80 (36%) 202 (34.1%)
Alleviating anxiety (N=639) Very Much 很多 2 (6.1%) 38 (10.5%) 17 (7%) 57 (8.9%) Moderate 一般 9 (27.3%) 105 (29.1%) 73 (30%) 187 (29.3%) Some 少許 13 (39.4%) 148 (41%) 96 (39.2%) 257 (40.2%) Not at all 沒有 9 (27.2%) 70 (19.4 %) 59 (23.8%) 138 (21.6%)
Relaxation (N=638) Very Much 很多 5 (15.2%) 38 (10.6%) 17 (7%) 60 (9.4%) Moderate 一般 7 (21.2%) 110 (30.6%) 67 (27.3%) 184 (28.8%) Some 少許 16 (48.5%) 143 (39.7%) 105 (42.9%) 264 (41.4%) Not at all 沒有 5 (15.1%) 69 (19.1%) 56 (22.58%) 130 (20.4%)
Essential Oil Used
Table 6 Women’s Satisfactory Report 1
Women’s Satisfactory Survey (con’t)
Women’s Satisfaction Neroli Sweet
Orange Bergamot Total
Discomfort noted while using Aromatherapy (N=637) NO 31 350 236 617 (96.9%) YES Nausea 0 3 5 8
Dizziness 2 3 0 5 Dry Mouth 0 1 0 1
Willing to use in next pregnancy (N=638) YES 27 268 175 470 (73.7%) NO, Why? Discomfort 0 1 1 2
Ineffective 5 76 59 140 Others (Scent is too strong, Plan not to pregnant again ) 1 5 5 11
Willing to recommend to other pregnant women (N=638) YES 25 288 184 497 (77.9%) NO, Why? Discomfort 0 0 2 2
Ineffective 8 63 56 127
Essential Oil Used
Table 7 Women’s Satisfactory Report 2
Conclusion
Aromatherapy NO significant adverse maternal and baby
outcomes Useful non-pharmacological pain relief
methods during labour Reducing labour pain Alleviating anxiety Enhancing relaxation
Limitations and Suggestions
Limitations Limited choices of Essential Oils Inhalation only
Suggestions Further studies on length of labour More trainings More varieties of Essential Oils used More methods used on Aromatherapy
References Buckle J, Ryan K and Chin KB. (2014). Clinical Aromathrapy for Pregnancy, Labour and Postpartum. International Journal of Childbirth Education. 29(4):21-27.
Burns E, Zobbi V, Ranzeri D, Oskrochi R and Regalia A. (2007). Aromatherapy in Childbirth: a pilot randomized controlled trial. BJOG. 114: 838-844.
Igarashi T. (2013). Physical and Psychologic Effects of Aromatherapy Inhalation on Pregnant Women: A Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. 19(10): 805-810.
Pollard KR. (2008). Introducing aromatherapy as a form of Pain management into a delivery suite. Journal of the Association of Chartered Physiotherapists in Women’s Health. 103: 12-16.
Price S and Price L. (2012). Aromatherapy for Health Professionals (4thed). Churchill Livingstone: Elsevier.
Rashidi-Fakari F, Tabatabaeichehr M and Mortazavi H. (2015). The effect of aromatherapy by essential oil of orange on anxiety during labour: A randomized clinical trial. Iranian Journal of Nursing and Midwifery Research. 29(6): 661-664.
Vakilian K and Keramat A (2013) The effect of the Breathing Technique with and without aromatherapy on the length of the active phase and second stage of labour. Nursing and Midwifery Studies. 1(3): 115-119.
Thank You!